My patient is still having seizures despite being started on anti-seizure medications
The most common cause of non-efficacy is non-concordance (previously known as non-compliance or nonadherence) with medication. Check blood anti-seizure medication levels wherever possible.
Phenytoin is the only anti-seizure medication where there is a correlation between blood levels and efficacy, it needs to be a pre-dose 'trough' level.
All other anti-seizure medications should be 'above zero' to indicate that the patient is taking some of their medication some of the time.
If it is impossible to get blood levels, the best first step may be to increase the dose of the extant anti-seizure medication according to local escalation guidelines:
Further guidance can be provided by the Epilepsy Specialist Nursing Team.
My patient is having side-effects from their anti-seizure medication
A suggestion for a second line agent will often be found in a patient's most recent clinic letter from their Epilepsy Team. This can be started and escalated according to local guidelines:
If a second line agent suggestion is not listed in the patient's most recent clinic letter, please seek support from the Epilepsy Specialist Nursing Team.
My patient has had an increase in seizure frequency
The most common cause of non-efficacy is non-concordance (previously known as non-compliance or nonadherence) with medication. Check blood anti-seizure medication levels wherever possible.
Phenytoin is the only anti-seizure medication where there is a correlation between blood levels and efficacy, it needs to be a pre-dose 'trough' level.
All other anti-seizure medications should be 'above zero' to indicate that the patient is taking some of their medication some of the time.
If it is impossible to get blood levels, the best first step may be to increase the dose of the extant anti-seizure medication according to local escalation guidelines:
Further guidance can be provided by the Epilepsy Specialist Nursing Team.
My patient has had a seizure after being seizure free for a long time
If the patient is cared for at University Hospitals Birmingham NHS Foundation Trust (UHB), please email the Epilepsy Specialist Nursing Team and include the:
- patient's hospital or NHS number
- name of the patient's usual consultant
If the patient is under the care of another epilepsy team, please contact the patient's usual neurology team.
If the patient has been discharged, they should be referred to the neurology team at their local secondary care provider via the 'first seizure' pathway.
The dose of the medication on the clinic letter doesn't match the GP record
Keep going with the dose that is recorded in the GP record and check with the patient's usual neurology team whether there was a plan to change to the new dose.
If the patient is cared for at UHB, please email the Epilepsy Specialist Nursing Team.
Can my patient drive? My patient is waiting to get their driving license back
For information on assessing a patients fitness to drive, please see the 'driving advice for seizure patients' page.
My patient is on sodium valproate, can I continue to prescribe this?
The first priority is to avoid seizures. The patient should continue on sodium valproate until an alternative plan can be actioned.
Patients of childbearing potential should not be started, or continue on, sodium valproate without being enrolled in the pregnancy prevention program. This does not mean the patient cannot take sodium valproate or must be on two forms of highly effective contraception. The patient must be made aware of the risks and available options, and be willing to sign informed consent to continue.
Patients of childbearing potential should be reviewed by their specialist team annually, the logistics of this are challenging and common sense needs to be employed in the implementation of the PPP.
Please contact the Neurology department at UHB via the A+R system if you need assistance with this issue.
Last reviewed 15 May 2024